Struggling to manage Thistle's pain

Thistle struggles so much at night. It's like from 9 pm until 8 am she is in agony, but during the day she's quite comfortable.

I added 6 mg of prednisone per day (4 in the morning 2 at night). That was a miracle, for a few days. Then we stepped up to 8 mg, now 10.

I have contacted her neurologist, he agreed to letting me just up her doses as needed. He believes in the prednisone as the main way to manage symptoms. I'm not a fan of that, but it is keeping her quieter. We still have some breakthrough screaming fits, but it's usually after I give a dose, so I know she's close to getting relief when it happens.

Would it be crazy to try to readjust her meds so that she gets something powerful at night (like tramadol) to just guarantee quiet nights, and then try to get her off the prednisone, and maybe even step back the gabapentin (she's now getting 600-800 mg/per day(3-4 200 mg doses depending on how she's faring). It'd be nice to have her down to maybe 400 mg/day if that's possible. But maybe tramadol isn't a good choice for something to give regularly? The rimadyl (carprofen) that we have does nothing for her.

It's just during the day she's not that bad, only occasional scratching (at night scratching means she's going to start screaming in a few minutes), and she seems fairly comfortable. Her breathing is ragged when she's suffering but not screaming, but that's really only at night.

I just don't know what to do with her.

Edit: I just noticed that adding an opiate, tramadol or amantadine is the next step on the algorithm. But amantadine sounds like a horrible drug, so I'll ask for tramadol.

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Originally Posted by sunshinekisses

I feel so bad for you and little thistle. I think others have given you good advice. Clearly she is in extreme pain right now. Maybe you can try to add another pain medication just for short term, but it sounds like trying the lyrica might be the trick. I hope you can figure this out. I am not a strong person and I can't bare to have my dogs in pain. I don't know if I could do long term what all the other SM dog owners have done for their dogs. The crying breaks my heart.

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I'm with you. When thistle starts screaming I can't do anything (it only takes a couple seconds to get her an extra dose), so I just sit there and cry. It's heartbreaking to watch her in so much pain.

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Originally Posted by Soushiruiuma

I'm with you. When thistle starts screaming I can't do anything (it only takes a couple seconds to get her an extra dose), so I just sit there and cry. It's heartbreaking to watch her in so much pain.

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I really feel for you, it is just awful to watch and it makes us feel so helpless. I hope you can get some help for Thistle soon.

Well, when I'm sick or hurting I always feel worse at night.... I have heard of people trying Melatonin at night too. Maybe just a little with a small dose of Tramadol would work. Its all trial and error with these treatments and it must be awful to have a dog you love so much go thur this. Thistle is so lucky to have an educated Mommy, hang in there.

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Originally Posted by MomObvious

Well, when I'm sick or hurting I always feel worse at night.... I have heard of people trying Melatonin at night too. Maybe just a little with a small dose of Tramadol would work. Its all trial and error with these treatments and it must be awful to have a dog you love so much go thur this. Thistle is so lucky to have an educated Mommy, hang in there.

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We tried melatonin. It's possible that it helped, a little. But it shouldn't be given while giving steroids, so that has been cut from our regimen for now.

Sorry Thistle hasn't found the right mix of medications yet. :(

Have you tried Lyrica rather than gabapentin? Sounds like she is already well up at about the limit of what she can take with gabapentin. Also is she on a CSF reducer? I would try her for a couple of weeks on each one, with support from your neuro or vet -- some people have good success with cimetidine, others with omeprazole. You might need to try different dosage levels. I know Clare tends to feel that many dogs need a regularly reviewed cocktail of two or more medications. She has a couple of painkillers that she uses.

I think it is really important to try and find a mix that works without worrying too much about the actual meds, though definitely go first with what you feel comfortable with -- many never get side effects or only minimal ones. I know a few neurologists that have prescribed amantadine.

One option is to do a phone consult with Clare, if you want a second opinion.

A second opinion might be a good thing. Ella was on a lot of medication but we found the right "cocktail". She was on several drugs you mentioned but I would still try lyrica. That got her off of amentadine for sometime. I can't remember the dosage of prednisone she was on but that helped with her mobility issues and pain (I feel).

She was also on tramadol and had frequent acupuncture that I believed helped. Everyone will say what works for one may not work for another. Ella didn't start on all this medication and there was a lot of trial and error. I do feel you should not do several changes at one time so that you can see what particular medication does what.

I am so sorry Thistle is in pain but if a certain medication made Ella feel better then that was the important thing. I hope things get better.

Thinking of you. I hope thistle is doing better. (HUG)

I have four dogs on cm/sm medication, there doesn't seem to be the same answer for all of them. All of them were on different doses of Gabapentin, Cimetidine and some were also on Trocoxil. I decided to switch them all over to Lyrica thinking it would make life easier medicating twice daily. Dougall who has cm, did not do very well at all, I even had his mri repeated to see if he had developed sm or to see if there was any damage to his spine. We increased the dose of Lyrica but it didn't make any difference. One night he started to scream! I put him on Tramodol, decided to put him back onto Gabapentin. Dougall is now on Gabapentin, Trocoxil, Cimetidine and a low dose of Tramodol which is new! Well he is now a changed dog, he sleeps through the night which he has never done before. There is slight sensitivity around his shoulders but the rest of the pain seems to be very much under control.



Each dog reacts differently, I am sure once you have found the right mix things will settle down.

I don't have any experience, but just hoping and praying you find the right combo to help Thistle out.

I know it must be heartbreaking to go through watching the pain....